Conference
- 2. Patient history 犖犖犖巌犢犖犖∇犖項犖犖迦権犖 31 犖犖 犖犖項検犖巌献犖迦犖犖 犖犖迦犖犖犖犖犖萎肩犖園 犖犖園犖犖о険犖犖犖伍牽犖朽牽犖園検犖∇ CC : 犢犖犖犖犖園犖犖犖犖犖犢犖迦犖犢犖犖犢犖犖 30 犖犖迦犖 PTA PI : 30 犖犖迦犖朽犢犖犖犖÷顕犢犖犖犖犖∇顕犖犖迦献犖犖項犖犢犖о権犖犖園犖犖犖犖犖犖萎犖萎肩犖迦検犖朽犖犢犖犖犖項犖犖園 犖犖犖萎肩犖犖犖伍犖園犖巌犖犖犖伍犖犖犢犖迦権犖犖 18 犖ム犖 犖о険犖犖犖朽 2/6/59 ,02.30 犖 犢犖犖∇犖園犖犖犖犖 犖犖迦犢犖犢犖÷犖園犖犖巌牽犖犖園権 犖犖項犖犢犖о権犖÷元犖犖迦犖迦牽犢犖犢犖犖犖朽犖犖犖犖園犖犖 犢犖犖犖犖園犖犖犖犖犖犢犖迦犖犖 犖犖∇険犖 犢犖÷犢犖犢 犢犖÷犖犖ム 犖犖迦犖犖犖伍犖迦牽犖犢犢犖犢 犢犖÷犢犖犢犖犖劇犖÷肩犖伍牽犖 犢犖÷犖÷元犖犖迦犢犖犖ム犖ム厳犖犖犖犖犖 犖犖迦権犖犖犖 犖犖項犢犖犢犖犢犖犖犖伍犖迦牽犖犢犢犖犖朽権犖犖犖犖犖伍犢犖犖巌犖犖犖犖犖園犖犖迦犖園硯犖犢犖犢犖犖犖犖∇顕犖犖迦献 犖÷見犖迦牽犖迦
- 3. Primary survey A : can speak , cant flex neck due to pain B : equal breath sound , CCT -ve C : no external bleeding , PCT -ve no sign of shock D : E4V5M6 , pupil 3 mm RTLBE , E : 犖犖項犖犢犖о権犢犖÷犖÷元犖犖迦犢犖犖ム犖迦検犖犢犖迦犖犖迦権
- 4. Adjunct 1 CXR : WNL Pelvis : WNL C-spine lateral view : CFx at pars interarticularis C2 FAST ve O2 sat 98%
- 6. Secondary survey A : paracetamol M : no current medication P : no U/D L : 22.00 犖 E : 犖犖犖犖巌犢犖犖犖ム犖犢犖犖犖犖犖犖萎犖園犖犖園 犖犖犖犖項犖犢犖о権犖犖園犖÷顕犖犢犖о権犖犖о顕犖÷犖犢犖 犖犖犖萎検犖迦 80 km/hr 犖犖迦検犖朽犖÷犢犖犢犖犖園犖犖迦犢犖犢犖犖犖伍犢犖犖 犖÷元犢犖犖犖犖犖犢犖 犢犖ム犖犖犢犖犖 犖犖園犖犖犖犖犢犖迦牽犖犖∇幻犖犖犖迦犖犢犖о
- 7. PE Head : no wound no tender Maxillofacial : no wound ,no tender ,no ecchymosis,no clot blood per nose Neck : tender along upper neck ,cant flex ,no wound ,no ecchymosis, no tender thoracolumbar Chest : no wound, no tender, eqaul breath sound Abdomen : no sign of peritonitis ,no wound Perineum : not tender Extremities :no wound , no deformities
- 8. Neuro : Motor Rt Lt C5 III II C6 III II C7 III II C8 III II T1 III II L2-S1 Grade IV both side PR good sphincter Sensory : decrease sensation C5-T1 both
- 9. Adjunct 2 Film Open mouth AP MRI C-spine Emer
- 12. Diagnosis Traumatic spondylolisthesis (Hangman s fracture)
- 13. treatment
- 15. Spinal cord injury Acute Phase Conditions Neurogenic shock : circulatory collapse from loss of sympathetic tone hypotension & bradycardia fluid management pressors to treat hypotension
- 16. Spinal shock : temporary loss of spinal cord function and reflex activity below the level of a spinal cord injury hyperpolarized and unresponsive to stimuli from brain flaccid areflexic paralysis , bulbocavernous reflex - usually resolves within 48 hours end of spinal shock = bulbocavernous reflex +
- 19. Central cord Syndrome - most common - motor deficit worse in UE than LE - good prognosis
- 20. Anterior cord lesion -lower extremity affected more than upper extremity -mimic complete cord syndrome -worst prognosis
- 21. Brown-Sequard Syndrome penetrating trauma ipsilateral deficit LCS tract ,dorsal columns contralateral deficit LST
- 23. management 犢犖犖劇犖犖犖犢犖 1. immobilize neck 2. Resuscitation 3.O2 犖犖伍犖犖迦権 4.Retain foley cath+NPO 5.犖犖萎硯犖園犖犖迦牽 load 犖犢犖 + pt 犖犢犖犖犖犖迦牽 500-1000 ml +犖∇犖犖 BD 犖犢犖о権犢犖犢 6. Methylprednisolone
- 24. 3.犢犖÷犖÷元 neuro deficit + x-ray not seen Fx 犢犖犢 conservative 4.犖÷元 neuro deficit 犖犢犖犖犖犢犖犖犢犖 犢犖犖犖迦鍵犖÷険犖犖÷元 instability 5.犢犖÷犖÷元 neuro deficit 犢犖犢犖÷元 instability 犖犢犖犢犖犖犖犢犖
- 25. 犖犖迦牽犖犖 instability Fx spinal body Fx dislocation spinal body Translation of spinal body > 3.5 mm Angulation in normal position or flex-extent > 11 犖犖犖犖(cobb angle) Abnormal open mouth view
- 26. cervical spine injury 犖÷元犖犖犖萎硯犖園犖巌賢犖伍犖園犖巌犖犖犖伍犖園犢犖犖 犢犖犖犖項犖犢犖о権犖犖朽犖÷元犖犖犖巌犖萎権犖犖犖迦犖犖巌犖犖犢犖÷犢犖犢 犖犢犖迦犖項犖犢犖о権犢犖犢犖犖犖巌犖犢犖犖巌犖о犖迦検犖朽犖迦牽犖犖迦犢犖犢犖犖犖犖萎犖項犖犢犖о犖犖犢犖犖÷賢犖犖犖犖о犖迦犖 犢犖犢犖犖園犖犖迦牽犖∇厳犖犖∇険犖犖犖迦 film
- 27. 犖犖迦牽犖犢犖迦 film C-spine Lateral view
- 28. Exposure ? Include C7 ? Prevertebral soft tissue -C1<10 -C2-C4 <5 -C4-C7 children <14 adult <22 Loss of lordotic curve ?
- 31. Open mouth view